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CHAPTER 1: DIVERSITY (DV)Diversity in health care
1) Cultuur
50% van de mensen in Antwerpen zijn migranten per regio is dit nog meer (Borgerhout 62,1%)
Culture = “the ideas, customs, and social behaviour of particular people or society.”
= een systeem dat ons helpt om ons te gedragen in een geaccepteerde, familiaire manier
De pyramide
Menselijke natuur: universeel en is geërfd
Cultuur: specifiek per groep of categorie en is aangeleerd
Personaliteit: specifiek per individueel en is geërfd en aangeleerd
An intercultural mediator
= a person who enables intercultural communication that helps
representatives of 2 different cultural communities communicate and understand each
other.
Bv: verpleegster doet een uitleg over borstvoeding aan een vrouw die uit een zeer sexuel
gesegregeerde cultuur komt en waar het genant is hierover te spreken met de man erbij.
De mediator kan hier zeggen dat het beter is dit gesprek te voeren zonder de man erbij.
Intercultural competence (doe online test)
Kan niet bereikt worden op een korte tijdsperiode of 1 module levenslang process
Slide 33: verschillende landen met hun kijk op intercultural competence of PT
Competence = knowledge-skills-attitudes (respect-openness-curiosity-discovery)
1) Knowledge
Cultural self-awareness
Benchmark: shows minimal awareness of own cultural rules and biases
Culture specific knowledge
Socio-linguistic awareness
Grasp of global issues and trends = cultural worldviews frameworks
Benchmark: understanding the complexity of elements important to
members of another culture in relation to its history, values, politics…
2) Skills
Verbal and nonverbal communication (listening, observing, evaluating
using patience and perseverance)
Benchmark: minimal level of understanding of cultural differences in
verbal and nonverbal communication, unable to negotiate a shared
understanding
Viewing the world from others’ perspectives
, Empathy
Benchmark: views experience of others through own cultural worldview
3) Attitude
Respect (valuing other cultures)
Openness (withholding judgement)
Benchmark: receptive to interacting with culturally different others
Curiosity (viewing difference as a learning opportunity)
Benchmark: minimal interest in learning more about other cultures
Discovery (tolerance for ambiguity)
Cross-cultural communication
C: consideration of culture
R: respect
A: assess and affirm
S: sensitive, self-awareness
H: humility, acceptance that you always have to learn
In every country
We see obligations set out to support the need to be respectful to a P’s cultural perspective
How can we, physiotherapists, provide culturally sensitive care?
2) Gender
There is a gender gap (some countries more than other)
Gender equality = the state of equal ease of access to resources and
opportunities, regardless of gender, including economic participation and
decision-making
Gender equity = a different treatment is adopted towards men and women,
according to their respective needs, in order to restore historical and social
imbalances (adjusted for their needs)
Pathways through which gender norms affect lifelong health:
- Gender related differences in exposures
o The same job title, but still different tasks and receive different pay
o Segregation in employment differential exposure to disease, disability and injury
- Gendered health behaviors
o Hazardous masculinities: not seeking medical care, reckless driving, substance use…
o Toxic femininities: toxic beauty products, facial plastic surgery…
- Gender impacts on accessing health care
o Some women’s access to health care is dependent on the consent of the
husband/gatekeeper for the provision of treatment
o By contrast, women’s increased decision-making autonomy and access to economic
resources is positively associated with their use of health-care services in many sub-
Saharan African countries.
o Similarly, in Pakistan, a 1% increase in women’s decision-making power was
correlated with a nearly 10% increase in their use of maternal health services.
- Gender-biased health-care systems
, o Women are stereotyped as fragile, overemotional health-related complaints are
very often interpreted as exaggerated and thus more psychosomatic rather than
physical causes
o Even in high income countries they get less aggressive, screened less often and
receive less aggressive treatment and substandard follow-up as exemplified by
cardiovascular care
o CAVE: equity over equality? Women not treated with the same parameters as the
treated man, and that is due to the risk of differences
In certain professional fields: women are
outnumbered!
Gender quotas? Problem or solution?
In some situations, it can be a good
solution, but we need to attack the
cause
If you talk about quota between men and
women, then you are thinking binary
You have a biological sex (male or female), but
also gender expression (more (fe)male) = the
way you express with actions, dress
But also, gender identity
Gender identity is how a person feels and who they know themself to be when it comes to their
gender. There are more than two genders, even though in our society the genders that are most
recognized are male and female (called the gender binary) and usually is based on someone’s
anatomy (the genitals they were born with). There are many different gender identities, including
male, female, transgender, gender neutral, gender fluid, non-binary, agender, pangender,
genderqueer (polygender), or a combination of these.
more woman-ness, more man-ness (what you feel like in your head)
But sexually attracted to + romantically attracted to is also important
3)
Socio-
economic status (SES)
, In India (caste system since 1950) they ask where the P lives address + appearance tells them
which class/SES they belong to they tailor make the therapy
If we look at obesity + the type of education
Meer overgewicht bij VSE = vocational secondary education (=BSO) door economische status
Impact of SES on health care
1) Some physicians are less likely to perceive low SES patients as intelligent,
independent, responsible, rational… and believe they are less likely to comply
with medical advice and return to follow-up visits
2) Some physicians believe that tailoring care options to a patient’s socioeconomic
circumstances can improve patient compliance and thereby improve health
outcomes.
3) There are also some physicians who do not care for patients of lower SES with
publicly financed insurance due to low reimbursement rates.
4) Unequal access to healthcare (lower income, less healthcare, higher risk for
unhealthy food…) is an important mechanism mediating socioeconomic
disparities in health status
Health advantages accrue to people with higher income, greater educational
attainment, and full-time employment due to, in part, better health insurance
coverage and greater access to primary and specialty medical care.
This may initiate a vicious spiral wherein poor health itself increases the risk of
unmet healthcare needs
The indifference not only 1 component but multiple
Health insurance in Belgium
• According to OECD data, 99% of Belgian residents can access treatment through the public
healthcare system.
• The Belgian healthcare system is funded by
• compulsory Belgian health insurance and
• social security contributions.
CHAPTER 2: PHYSICAL ACTIVITY AND BEHAVIOR +
PREP PROJECT
Mental health care system:
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